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Knee Pain

Arthritis of the Knee
Many people are told that their knee pain is due to “wear and tear” and are informed that they have Arthritis.  However there are over 100 different types of arthritis, some of which are very rare.

Preventing knee pain

• The Quadricep muscles (thigh), play an important role in the stability and strength of the knee.  Keeping these muscles strong is important.
• Always use protective knee pads if your work involves a lot of kneeling.
• Keep active – The “use it or lose it” scenario is true of all joints and muscles in our body.  Regular exercise helps strengthen bone and muscle.
• Sports specific strengthening exercises help prepare the knee for winter sports and those such as rugby and football.
• Avoid being overweight – In a lifetime, your knees will have to carry many tons of weight, adding to this will increase the risk of Osteoarthritis.
• Runners should always change their running shoes about every six months, as their shock absorbing capacity declines, placing undue stress on the knee joint.

Anatomy of the knee – Take a closer look at the knee joint.

Knee pain- Take a more in depth look at the different causes of knee pain.

Exercises for the knee – A selection of basic, intermediate and advanced exercises to strengthen the knee.

Arthritic conditions of the knee – Find out more about Osteoarthritis of the knee

Knee Resurfacing & replacement – Different techniques to replace worn or damaged knee structures.

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Policeman’s Foot website

A new website has been launched to help sufferers of the painful foot condition, Plantar Fasciitis.

Called policemans-foot.com the website explains in both technical and jargon free text and images the medical complaint that affects thousands of people around the world.

The unusual website name came about because historically plantar faciitis was seen in people who were on their feet for many hours, such as policemen.

Maureen Flett, the owner of TheSportsphysio.com, who has put the site together said that “She gets many people through her clinic in Carlisle who have stabbing unbearable foot pain and she just wanted a way to help them understand what was possibly going on. A website helps many people do this and comment upon their experiences of both treatments and the condition”.

Plantar faciitis is a very painful condition affecting the tendons in the sole of the foot.

It has many causes, some which are easily treated by using orthotics or changing footwear and others which require more intensive treatment and long term care.

” I would always recommend anyone in pain to seek professional medical attention ” added Maureen, ” However, understanding a condition often helps remove the stress a patient quite rightly feels”.

Plantar fasciitis has many other names such as “Dog’s Heel”, “Policeman’s Foot” or “Flip Flop disease.

Maureen hopes that over the next few years the website will grow to be the source on the web for articles and information on the medical condition and is asking for professionals and sufferers to get in touch.

TheSportsmedic.com is owned by TheSportsphysio.com

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Carpal Tunnel Syndrome

Carpal Tunnel Syndrome or Median Neuropathy is caused by compression of the median nerve at the front of the wrist. Pain or weakness in the hand and forearm is often accompanied by tingling and sometimes numbness in the fingers.

The carpal tunnel is formed by the transverse carpal ligament passing over the bones (carpals) and soft tissues of the inside of the wrist. Running through this carpal tunnel are the tendons (flexor tendons) that allow you to curl your fingers to grip things.

Also running through this tunnel alongside the flexor tendons, is the Median nerve.

This nerve originates from your neck area and is one of three nerves that connect to your hand. Appart from transmitting sensation from the thumb and fingers to the brain, it is also responsible for controling some of the muscles of the thumb.

The main fingers affected by this nerve are particularly the index, middle and (occasionally) the ring fingers.

For various reasons, pressure/repeated use of this area, causes the tendons to swell and overfill the carpal tunnel, placing pressure on the median nerve.

What causes carpal tunnel syndrome?
Carpal tunnel syndrome develops for a variety of reasons and in some cases can get better without treatment.  It is known that women tend to be affected more than men.

Some factors which can lead to development of CTS are;

• A fracture or injury of the wrist
• Carrying out manual tasks that you are not used to or for too long a period, such as pruning, clipping hedges, DIY.
• Rheumatoid arthritis or other conditions affecting the joints
• Osteoarthritis in the wrist
• Growth related medical conditions such as acromegaly
• Fluid rention (such as during pregnancy or menstrual cycle)
• Being overweight
• Diabes
• Underactive thyroid gland
• Certain medicines, such as oral contraceptives

People who’s occupations involve repeated use of the hands or strain on the wrist are at risk of developing CTS.

There are other conditions which have similar symptoms to Carpal tunnel syndrome, such as a trapped or damaged nerve in the neck or shoulder region.

Symptoms of carpal tunnel syndrome

• Pain or aching, in the hand, forearm and sometimes the upper arm.
• Tingling or numbness, mainly in the thumb and first three fingers.
• Weakening grip and pain (especially at the base of the thumb and wrist) when performing tasks such as buttoning a shirt or sewing.

Symptoms are usually worse in the thumb, index and middle fingers but can affect your whole hand. The aching may sometimes extend up into the forearm as the muscles are put under increasing strain. Problems can even appear at the elbow and even the shoulder and neck as the body subconsciously adapts movements to accommodate the damaged wrist.

It is usually the dominant side that is affected, ie: if you are right handed, the symptoms will usually appear in this hand but it can affect both hands. Sometimes because of the cause of the condition and sometimes because we use our non dominant hand more in order to rest and compensate for the injured one.

Pain and aching is usually worse at night and feels like a deep tooth ache, often disturbing the sufferers’ sleep. Tightening and contraction of the tendons and soft tissues during the night, often means that opening your fingers or gripping can be very painful in the morning.

Once the person is active, symptoms may ease as tissues warm and become more flexible, but the pain and tingling can appear during the working day, especially if the person carries out tasks which involve the hands.

Diagnosis of Carpal tunnel syndrome
A detailed history of how the condition started and what the symptoms are, is usually enough but a doctor or therapist will sometimes confirm their suspicion by tapping on the median nerve area over the wrist and ask the patient to flex the wrist to see if the symptoms appear, this is called Tinnel’s sign. If the practitioner is unsure or if the test is positive, you may be referred to a specialist to find out the extent of the damage to the median nerve.  They do this by performing a nerve conduction test.

Treatment of CTS
The first aim of treatment for CTS is to reduce pressure on the median nerve and the earlier that treatment begins, the more effective it is.
You may be sent for ultrasound treatment to reduce swelling in the tendons, along with massage and mobilisation of the wrist to help reduce muscle spasm and tightness in the tendons.

Your doctor or therapist will try to determine the cause of the problem and if necessary advise on changes that need to be made. Sometimes, changing the way you carry out a task and how often you rest may resolve the problem.

You may be advised to perform special stretching exercises, apply cold compresses or even use a specially designed Carpal tunnel splint at night or even during the day to help keep the wrist straight, easing compression on the carpal tunnel.

In most cases, anti-inflammatory drugs such as ibuprofen do not seem to help, but you may require a strong painkiller.

Depending on the severity of the condition, your medical practitioner may prescribe steroid tablets such as Prednisolone or even steroid injections into the carpal tunnel.  This may not always be successful.
Some people find that acupuncture or the use of a TENS machine helps to relieve symptoms of carpal tunnel syndrome.

In some severe cases, surgery may be needed to release the carpal tunnel. The simple procedure is carried out to make more space in the carpal tunnel by cutting the ligament which is placing pressure on the tendons and nerves.

Most cases of CTS are effectively treated with physiotherapy techniques if the condition is caught in the first few weeks.

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Going out in the snow & ice.

The start of 2010 has seen many hospital casualty departments stretched to their limit with injuries from slips and falls on the snow and ice.

Higher than average snow fall combined with the lowest temperatures for many years, has created packed ice on Britian’s roads and pavements, making driving and walking treacherous.

Demand on gritting resources and manpower has resulted in only the major roads being gritted.  Many minor roads and pathways remain untreated and special care needs to be taken when out and about.

With the right clothing and equipment, a walk on a winter’s day can be a very rewarding experience.  The light and scenery can be literally breathtaking, making us view our environment in a whole new way.

For many, the prospect of having to walk on ice and snow just fills us with dread.  The fear of slipping and injury is enough to keep most people indoors.  However, by following a few simple rules, we can adapt to the surroundings and get on with our daily lives.

Walking on ice and snow
Many of the slips and falls on ice and snow can be prevented by taking a few simple precautions, for example, wearing the appropriate footwear.

• Only use shoes or boots designed for rough terrain or ice and snow, such as those found at outdoor and mountaineering shops.  These offer greater grip, as well as additional stability for the foot and ankle.
• Fashion boots and dress shoes are not designed for the “off road” conditions we now find in our urban areas.

Additional grip.

A number of products are now available to offer additional grip, stability and in turn, confidence, when venturing out from the comfort of your home.

• There are many “over shoe” products on the market specially designed to offer additional grip for your footwear in ice and snow.
• An older trick, (probably more suited to short or emergency journeys) is to wear a pair of thick, natural fibre (cotton/wool) socks over your shoes.
• Use walking poles.  Walking poles are specially designed pieces of equipment which offer a little more stability in slippery conditions.  Many designs offer a carbon tip to aid grip. They are often telescopic and can fit neatly into bags and backpacks allowing them to be handy at all times, including the journey between the car and the office.
• If you usually use a walking stick, this can easily slip in snow and ice.  You can obtain special ferrules (end caps) for some sticks or simply use a walking pole instead.

Keep warm.

• Wearing a few layers of light clothing offers more warmth than one thick layer.
• Two pair of socks will help to keep the feet warm allowing the muscles and tendons to work more efficiently, it also helps avoid blisters.
• Hats, scarves and gloves – help to stop heat loss from the extremities.  A great deal of body heat is lost through the head.
• When the outside temperature is cold, your body will naturally protect essential organs reducing blood flow to the extremities. The reduced blood supply to hands and feet makes them easily prone to ‘frost nip’ in fingers and toes. This is why your fingers and toes feel the cold first.
• Protecting your hand and feet from the cold, is essential for sufferers of some medical conditions.  An example of this would be Raynaud’s syndrome,
• Remember that children and the elderly often cannot regulate body temperature and will more readily suffer the effects of cold, without even being aware. Hypothermia is a greater risk in these age groups.

Use backpacks.

• Using a backpack to carry your items, will distribute weight better than carrying a bag in one hand.  It also leaves your hands free for using walking poles and hand rails.
• Backpacks also offer you the additional space to carry your office shoes for when you get to work.

Choose your route carefully.

• Consider alternate routes when planning your journey.  Try to avoid steep hills and routes close to water such as canals and riverbanks.
• Let somebody know you are going out and when you should expect to be back.
• Walk towards the inside of the pavement – you are less likely to fall off the edge of the kerb, as this may be hidden by snow and it also reduces the risk of  falling into the path of vehicles.
• Avoid stepping in icy puddles.  They may be deeper than you think and wet feet will freeze rapidly.
• Allow more time for your journey.
• Charge your mobile phone and take it with you.  If you do get injured, you need to get help quickly to avoid further problems such as hypothermia.
• It may be attractive to walk on a treated road rather than the slippery pavement.  However, you must consider the drivers who will not be expecting you there;

1. Wear reflective clothing to make yourself visible.
2. Walk on the right, facing oncoming traffic.
3. Step back onto the pavement where possible to let vehicles pass, giving them plenty of space.
4. The driver may not be able to stop quickly or at all and the vehicles are likely to be unpredictable.
5. The driver’s vision may be impeded by conditions, assume they cannot see you.

Protect your eyes from the winter sun.

Skiiers are only too aware of the effects of sun on snow and protect their eyes with sunglasses or goggles.

• Glare from low bright sunlight may not allow us to see the pathway or road clearly.
• Sunlight on the eye is thought to be the major cause of cataracts.

Is your journey necessary?.

• This is an ideal opportunity to support your local store, milkman or mobile shop.
• Plan your requirements for a few days ahead.  Milk, bread, eggs and veg will all keep in the fridge for a number of days.
• Many stores now offer an online/ home delivery service. These services may offer a solution for essential goods, avoiding the additional risks of leaving your property and unwarranted car journeys.  Consider asking neighbours if they have any requirements to avoid multiple delivery journeys.

Should you be unfortunate enough to injure yourself falling on the snow and ice, visit our Sportsphysio website for some helpful advice.

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Biofreeze pain relieving gel

BIOFREEZE  COOL SOOTHING RELIEF is the only natural pain relieving analgesic with ILEX, a herbal extract from a South American holly shrub.

The ILEX works to extend the properties of the three analgesics contained in BIOFREEZE. The result is a deep, long lasting pain relief period and acceleration of the basic healing process through relaxation of stiff, aching muscles.

Biofreeze Roll-on or Biofreeze Gel  can also help to relieve pain caused by Arthritis and Neuropathy. Users receive pain relief within minutes and after two or three applications of Biofreeze maximum benefits can be felt.

BIOFREEZE does not use waxes, oils, aloe or petroleum. The result is a fast-acting, deep penetrating, long lasting pain reliever.

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The Cryocuff cold therapy system

Cryo Cuff by Aircast® combines focal compression with cold to provide optimal control of swelling, edema, hematoma, hemarthrosis, and pain.

Simplicity of design and ease of operation makes it ideal for the ER, post-op, training room and home.

The Aircast AutoChill system enhances the Cryo Cuff with two unique functions: continuous cold and pulsating pressure. Continuous cold eliminates the need for manual water recycling by utilizing an electronic pump to exchange warm water for cold.

Pulsating pressure resulting from the automatic exchange of water provides comfort and therapeutic benefits of intermittent compression.

The items below are selected from our best sellers. Click on any link to view the complete range.

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Powerbreathe

POWERbreathe is an Inspiratory Muscle Trainer, exercising and strengthening the muscles we use to breathe.

Inspiratory Muscle Training (IMT) is scientifically proven to benefit patients with respiratory illness and healthy people, including athletes at all levels of competition, including Olympians.

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Knee Braces for Skiing & Snowboarding

As winter approaches, many people with knee problems request our advice on the best type of brace to support the knee whilst skiing.  The answer depends on the type and severity of the problem.

Three of the most common problems affecting the knee;

Knee pain when skiing.

This can be a complex issue but in short, if you are only experiencing knee pain when skiing, then it is most likely that the knees are just not used to this type of activity.  Skiing is not like riding a bike, you cannot just stop and start when you wish and expect your body to adapt quickly.  Strength is required, not just from the knee joint itself but from the Quadriceps (muscles in the front of the thigh) and the Hamstrings (muscles at the back of the thigh).

It is very important that you embark on a programme of fitness training leading up to your skiing, specifically designed to target these areas.  Your local fitness instructor or sports injury specialist will be able to design a programme for you.

If you suffer from painful knee joints at other times, such as walking, going up and down stairs and/or pain at rest, you must consult a medical professional before attempting sports such as skiing.

Do not rely on a knee brace or support to reduce knee pain.

An injured ACL (Anterior Cruciate Ligament)

Commonly found in football and rugby injuries as well as previous skiing accidents, a damaged or previously ruptured ACL means that one of the ligaments situated in the middle of the knee joint, attaching your lower leg to your upper leg has been compromised in some way.  This may be a minor strain or a major rupture which has required surgery.

Damage to the ACL can often result in instability, this means that when the knee joint is under pressure, such as walking downhill, down stairs or skiing, it may give way and some people experience this “giving way” even during normal activity.

A medical professional trained in sports injuries can assess the joint to see if there is any instability and will advise you on the level of activity you can safely undertake.  For mild strains, strengthening and stability exercises should suffice, but more serious ruptures may mean that you will not be able to ski or snowboard.

In moderate cases, a practitioner will allow you to ski but recommend the use of an appropriate brace. The type of support needed for this purpose is complex and must be specifically designed to limit the movement between the upper and lower leg when the knee is slightly bent. They will be labelled ACL & PCL. A normal neoprene knee support will not suffice.

Damage to the Medial and Lateral Ligaments of the knee.

Again, often football, rugby, squash or skiing related injuries, but this time the ligaments attaching the upper and lower leg bones together on the inside (medial) and outside (lateral) of the knee have been damaged.

As with any ligament injury, the damage can result in instability but this time when the knee is stressed from side to side (exactly as it is in skiing).

If your therapist has advised that you ski using a brace, then you need one that offers medial and lateral support and will be labelled MCL and LCL.

These braces have metal stays or springs on the inside and outside of the knee to support any sideways movement.

Never rely on a brace to compensate for serious joint laxity, if you experience “giving way” of the knee joint during normal activity or mild sporting activity you should never attempt to ski or snowboard.  It may be possible that surgery is required to stabilise the knee.

If you are in any doubt about a knee injury and your fitness to ski, please seek medical opinion.  This article is not intended to be used for diagnosis of an injury.

Sports Injury Specialist

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Swine Flu Latest

Keep up to date with latest information relating the the swine flu outbreak.

The Department of Health has stated that The World Health Organization has raised its alert over the spread of swine flu to level five – one short of its highest alert level.
Phase five means that person-to-person spread of the virus has taken place in at least two countries.

A leaflet published by The Department of Health, which will be delivered to people’s doors nationwide early next week. It explains swine flu and how it could spread, what UK governments have done to prepare for a wider outbreak of flu, how people can protect themselves against flu as well as what to do if they have flu symptoms.

Download the Swine flu information leaflet (PDF, 912K)

CATCH IT. BIN IT. KILL IT
A mass public health campaign has begun today with TV, print and radio adverts warning people about swine flu with the simple message: CATCH IT. BIN IT. KILL IT.

It is important to emphasise that in all cases outside Mexico, the symptoms of this illness are mild and all patients have made a full recovery.

Take simple measures to prevent infection.

Wash Hands Regularly and where washing facilities are unavailable or when travelling, consider using an antibacterial gel for the hands, such as that used in medical establishments.

Sneeze or cough into a TISSUE handkerchief (Not your hand), ensuring that both the nose and mouth are covered. Then dispose of the tissue IMMEDIATELY.

Anyone who develops flu-like symptoms should go home and contact their GP.
Anyone who has recently travelled to the affected areas and is experiencing influenza-like illness should stay at home to limit contact with others and seek medical advice by phone from a local health professional or NHS Direct.

Ensuring a clean home or workplace free of bacteria will keep you healthy and mobilis direct offers some of the best cleaning products available. With sterilisation products, disposable gloves and masks, and wipes and sprays for both surfaces and the skin, you can keep your environment clean.

For information on the health and hygiene aspects of swine flu, visit the Department of Health website.
Swine flu – health protection advice

Swine flu – travel advice from the DOH
If you have recently visited one of the countries or areas where human cases of influenza have been identified, or are planning to do so, read the advice for travellers.
Swine flu – travel advice

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Aquaflex Pelvic Floor Exercise System

The simple and effective way to strengthen pelvic floor muscles and treat incontinence problems, as seen on Channel 4’s Embarrassing Bodies.

Aquaflex Vaginal Cones
are one of the most widely used pelvic floor muscles exercise systems in the UK.

Aquaflex Cones are clinically proven pelvic floor muscle exercise systems consisting of weighted vaginal incontinence cones, specially designed to improve pelvic floor muscle tone.

Aquaflex Cones help to improve general pelvic health by strengthening weak pelvic floor muscles, restore bladder control, and can also improve sexual response and satisfaction.

Aquaflex Vaginal Cones are also ideal for use before and after pregnancy to prepare the pelvic floor muscles for child birth and strengthen the muscles following child birth. Please note: Aquaflex Cones should NOT be used during pregnancy.

Used for just 20 minutes a day, an improvement in pelvic floor strength can be expected in just 12 weeks! Recommended by health professionals worldwide, Aquaflex Cones are an effective treatment for pelvic floor problems.

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